Project

Monetary incentives are directed at patients and coupled with culturally tailored outreach and education materials.

The incentives are based on improving HbA1c levels, and the schedule of incentives will incorporate several factors. Those factors include: frequent monitoring of HbA1c, payments for achieving small, manageable milestones in reducing HbA1c, larger payments for larger reductions in HbA1c, larger required reductions in HbA1c levels for subjects with higher baseline levels, and larger required reductions in the long term versus the short term.

The culturally tailored outreach and education materials include DVDs, fast food and cooking guides, a fotonovela, a depression awareness guide, and webinars. Two rounds of postcard reminders are sent to members to encourage use of the materials.

The outreach materials were developed collaboratively with Latino and African American members of WellPoint’s health plans in order to be culturally relevant. WellPoint employed qualitative participatory research techniques to determine members’ knowledge of diabetes and how they get this information, resulting in clear guidelines for cultural themes to be addressed in a health education program that is effective despite inter- and intra-cultural differences.

Rationale

This intervention aims to improve glycemic control in patients with poorly controlled diabetes through a variety of mechanisms.

Monetary incentives are intended to provide extrinsic motivation for patients to take the steps required to improve control of their diabetes. The schedule of incentives, based on principles from behavioral economics, attempts to motivate patients in a variety of ways. In particular the incentive system was developed to motivate patients who are making slow progress and prevent them from becoming discouraged; reward greater effort and success in achieving glycemic control; and promote eventual achievement of good glycemic control.

The culturally tailored outreach is intended to influence the context in which patients make decisions that affect glycemic control, thereby potentially amplifying the effect of the monetary incentives, and to provide the intrinsic motivation, information and support members need to sustain glycemic control after the incentives are withdrawn.

Summary Results

Financial incentives of $60, $90, or $125 were mailed to patients at four and eight months for achieving specific HbA1c reduction targets, which are based on patients' baseline HbA1c levels. These financial incentives, combined with culturally tailored outreach and educational materials, did not improve HbA1c levels, medication adherence, patient activation, or diabetes self-management behaviors relating to diet, exercise, and home monitoring of blood sugar.

Publications

Principal Investigators

Grace Huang Ting, MHA(Health Services Director, WellPoint, Inc.)

José J. Escarce, MD, PhD(Professor of Medicine, University of California at Los Angeles)

Arleen Brown, MD, PhD(Associate Professor of Medicine, University of California at Los Angeles)